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Almost one-quarter of college women try hookah smoking during their freshman year, a new study finds. The researchers found the more alcohol the women drank, the more likely they were to try hookah smoking. Those who used marijuana engaged in hookah smoking more often than those who didn’t, according to Science Daily.

The study included 483 first-year female college students, who completed an initial survey about their precollege hookah use, followed by 12 monthly online surveys about their experience with hookah smoking.

The researchers note hookah smoking has increased dramatically among young adults over the past 20 years. Many college students mistakenly believe hookah smoking is safer than smoking cigarettes. Hookah smoking has been linked to many of the same diseases caused by smoking cigarettes, including lung cancer, respiratory illness and periodontal disease, the researchers from The Miriam Hospital Center note in a news release.

“The popularity and social nature of hookah smoking, combined with the fact that college freshmen are more likely to experiment with risky behavior, could set the stage for a potential public health issue, given what we know about the health risks of hookah smoking,” said lead author Robyn L. Fielder.

Hookah bars feature water pipes that are used to smoke a blend of tobacco, molasses and fruit called shisha. The World Health Organization (WHO) noted in a report that the smoke inhaled in a typical one-hour hookah session can equal 100 cigarettes or more. The WHO report also stated that even after it has been passed through water, the tobacco smoke in a hookah pipe contains high levels of cancer-causing chemicals.